Natural Standard® Patient Monograph, Copyright © 2014 (www.naturalstandard.com). All Rights Reserved. Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.

Background
Melatonin is a hormone produced in the brain by the pineal gland from the amino acid tryptophan. The production and release of melatonin are stimulated by darkness and decreased by light, suggesting that melatonin is involved in circadian rhythm (the internal body clock) and regulation of diverse body functions. Levels of melatonin in the blood are highest prior to bedtime.

The most common use of melatonin is to aid in sleep. The strongest evidence supporting the use of melatonin is for delayed sleep phase syndrome, insomnia in children and the elderly, jet lag, and sleep problems in people with behavioral, developmental, or mental disorders. The weakest evidence in support of melatonin is for work shift sleep disorder. Good evidence in support of melatonin for other uses is lacking.
New drugs that block the effects of melatonin are being developed. These include BMS-214778 and luzindole, and they may have uses in various disorders.

Related terms
5-Methoxy-N-acetyltryptamine, 6-sulfatoxymelatonin, acetamide, agomelatine, aMT6s, beta-methyl-6-chloromelatonin, BMS-214778, CAS 73-31-4, hypnotic, indole, luzindol, luzindole, mel, MEL, melatonia, melatonine, Melaxen®, melaxene, MLT, MT, N-2-(5-methoxyindol-3-ethyl)-acetamide, N-acetil-5-metoxitriptamina (Spanish), N-acetyl-5-methoxytryptamine, neurohormone, ramelteon (CAS 196597-26-9, TAK-375), tryptophan.

Brand names: Accurate Release®; Appleheart Melatonin®; Circadin®; Inspired by Nature®; Mel®; Melatonin Controlled Release®; Melatonin Olympian Labs®; Melatonin Tablets®; Melatonin Time Release®; Melatonin-BioDynamax®; Melatonin-Metabolic Response Modifier®; Melatonin-New Hope Health Products®; Melatonin-Optimum Nutrition®; Melaxen®; Nature’s Bounty®; Puritan’s Pride®; Rozerem®; Twinlab® Melatonin; Valdoxan®.

Combination product examples: Melatonex® (vitamin B6); Melatonin Forte® (Piper methysticum, kavalactones, valerian); Melatonin PM Complex® (vitamin B6, vitamin B2, vitamin B3); Melatonin spray® (gamma-aminobutyric acid, pyridoxal-5-phosphate); Super Snooze with Melatonin® (valerian root, hop, skullcap, chamomile, passionflower).

Dosing
The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Adults (over 18 years old)
The time of day that melatonin is taken is important. Melatonin impacts circadian rhythms (the internal body clock) differently depending on whether it is taken in the morning, afternoon, or early evening.

For age-related macular degeneration (vision loss with age), three milligrams of melatonin have been taken by mouth nightly at bedtime for six months.
To improve body temperature regulation in the elderly, 1.5 milligrams of melatonin has been taken by mouth nightly for two weeks.

For Alzheimer’s disease or cognitive decline, melatonin has been taken by mouth in doses of 1-10 milligrams daily for 10 days up to 35 months.
For inflammation, melatonin has been taken by mouth in doses of 10 milligrams nightly for six months or five milligrams the night before and one hour before surgery.
For asthma, three milligrams of melatonin has been taken by mouth for four weeks.
For withdrawal from benzodiazepines (antianxiety agents), doses of 1-5 milligrams have been taken by mouth daily for from several weeks up to one year.
For cancer, melatonin has been taken by mouth in doses of 1-40 milligrams daily, with 20 milligrams being most common, for several weeks to months. Melatonin has been applied to the skin.

For chronic fatigue syndrome, five milligrams of melatonin has been taken by mouth five hours before bed for three months.
For COPD (chronic lung disorder causing breathing difficulty), three milligrams of melatonin has been taken by mouth nightly two hours before bed for three months.
For circadian rhythm sleep disorders in people with and without vision problems, melatonin has been taken by mouth as a single dose of 0.5-5 milligrams before bed or as a daily dose for 1-3 months.

For delayed sleep phase syndrome, melatonin has been taken by mouth in doses of 0.3-6 milligrams, with five milligrams being most common, daily before sleeping for two weeks to three months.
For delirium, 0.5 milligrams of melatonin has been taken by mouth nightly for up to 14 days.

For depression, six milligrams of slow-release melatonin has been taken by mouth at bedtime for four weeks.
For exercise performance, 5-6 milligrams of melatonin has been taken by mouth one hour before exercise or before bedtime.

For fertility, three milligrams of melatonin has been taken by mouth nightly from the third to fifth day of the menstrual cycle until hormone injection (human chorionic gonadotropin, HCG), or on the day of hormone injection.
For fibromyalgia, 3-5 milligrams of melatonin has been taken by mouth nightly for four weeks to 60 days.

For stomach and intestine disorders, 3-10 milligrams of melatonin has been taken by mouth nightly for 2-12 weeks.
For headache, 2-10 milligrams of melatonin has been taken by mouth nightly for 14 days to eight weeks.
For liver inflammation, five milligrams of melatonin has been taken by mouth twice daily for 12 weeks.

For high blood pressure, melatonin has been taken by mouth in doses of 1-5 milligrams either as a single dose during the day or before bedtime, or daily for 1-3 months.
For high cholesterol, five milligrams of melatonin has been taken by mouth daily for two months.

For insomnia in the elderly, melatonin has been taken by mouth in doses of 0.1-5 milligrams at or two hours before bedtime for up to several months, in the form of melatonin-rich night milk or slow-release Circadin®. A dose of 0.5 milligrams has been placed in the cheek for four nights.

For jet lag, 0.1-8 milligrams of melatonin has been taken by mouth on the day of travel (close to target bedtime at destination), then daily for several days, in the form of standard or slow-release melatonin (Circadin®).

For memory, three milligrams of melatonin has been taken by mouth before testing.
For menopause, three milligrams of melatonin has been taken by mouth nightly at bedtime for 3-6 months.

For Parkinson’s disease, doses of 3-50 milligrams have been taken by mouth nightly before bed for 2-10 weeks. (High doses of 3-6.6 grams of melatonin have also been taken by mouth daily; however, these doses were used in an older 1972 study and are no longer in use.)

For periodic limb movement disorder, three milligrams of melatonin has been taken by mouth nightly for six weeks.
For REM sleep behavior disorder, 3-12 milligrams of melatonin has been taken by mouth daily for four weeks.
For restless leg syndrome, a single dose of three milligrams of melatonin has been taken by mouth.

For sarcoidosis (chronic widespread inflammation), 20 milligrams of melatonin has been taken by mouth daily for one year, then decreased to 10 milligrams for a second year.
For muscle movement problems in people with schizophrenia, 2-10 milligrams of melatonin has been taken by mouth daily.

For seasonal affective disorder (SAD), two milligrams of sustained-release melatonin has been taken by mouth 1-2 hours nightly for three weeks. A dose of 0.5 milligrams of melatonin has been taken under the tongue for six days.
For seizure disorders, doses of melatonin taken by mouth were 3-10 milligrams daily for 2-4 weeks to three months.

For sleep (general), doses of melatonin taken by mouth were 0.3-10 milligrams.
For sleep disorders in people with behavioral, developmental, or mental disorders, 0.1-10 milligrams of melatonin has been taken by mouth daily for up to one year.
For sleep disturbance in Alzheimer’s disease, 1.5-10 milligrams of melatonin has been taken by mouth nightly for 10 days to 35 months, together with light exposure or in the form of capsules.

For sleep disturbance in those with asthma, three milligrams of melatonin has been taken by mouth for four weeks.
For sleep disturbance in those with autism, 0.75-10 milligrams of melatonin has been taken nightly before bedtime for two weeks to six months.
For sleep disturbance in those with COPD, three milligrams of melatonin has been taken by mouth nightly.

For sleep disturbance in those with cystic fibrosis, three milligrams of melatonin has been taken by mouth nightly at bedtime for 21 days.
For sleep disturbance in those with depression, 0.5-10 milligrams of melatonin has been taken by mouth for 3-4 weeks, in addition to regular therapy.

For sleep disturbance in healthy people, 0.1-80 milligrams of melatonin has been taken by mouth, generally nightly before bed for one or several days up to 26 weeks. A dose of 50 milligrams has been injected into the vein.
For sleep disturbance in people undergoing hemodialysis, three milligrams of melatonin has been taken by mouth for six weeks.

For sleep disturbance in hospitalized and medically ill people, 3-5.4 milligrams of melatonin has been taken by mouth nightly.
For sleep disturbance in people with a learning disability, 0.5-9 milligrams of melatonin has been taken by mouth for 32-73 days.

For sleep disturbance in those with Parkinson’s disease, 3-50 milligrams of melatonin has been taken by mouth at bedtime for 2-4 weeks.
For sleep disturbance after surgery, five milligrams of melatonin has been taken by mouth for three nights.

For sleep disturbance in people with mental disorders, 2-12 milligrams of melatonin has been taken by mouth daily before resting for up to 12 weeks
For sleep disturbance in people with traumatic brain injury, five milligrams of melatonin has been taken by mouth for one month.

For sleep disturbance in people with tuberous sclerosis complex (a genetic disorder causing tumors to grow in brain and other organs), five milligrams of melatonin has been taken 20 minutes before bed for two weeks.
For smoking, 0.3 milligrams of melatonin has been taken by mouth 3.5 hours after nicotine withdrawal.

For surgery, 3-15 milligrams of melatonin has been taken by mouth or placed under the tongue, and 0.05-0.2 milligrams per kilogram has been placed under the tongue, either alone or with other sedatives, typically 90 minutes before surgery or the night before and 90 minutes before surgery. For anxiety or sedation before surgery, 3-10 milligrams and/or 0.05-0.5 milligrams per kilogram of melatonin have been injected into the vein, either alone or with other sedatives before surgery.

For tardive dyskinesia (uncontrolled, repetitive movements), 2-20 milligrams of melatonin has been taken by mouth for 4-12 weeks.
For low platelets, 20 milligrams of melatonin has been taken by mouth nightly for two months.

For ringing in the ears, three milligrams of melatonin has been taken by mouth daily for up to 80 days.
For ulcers, five milligrams of melatonin has been taken by mouth twice daily for 21 days together with other medications.
For nighttime urination, two milligrams of melatonin has been taken by mouth daily for four weeks.

For work shift sleep disorder, 1.8-10 milligrams of melatonin has been taken by mouth up to three times daily for up to six days before daytime sleep after a night shift.
For skin sun damage, melatonin has been applied to the skin in the form of a gel (20-100 milligrams of melatonin in 70% ethanol, in concentrations of 0.05-0.5% in 0.12 milliliters of gel); 0.6 milligrams per meter squared from 15 minutes before to 240 minutes after sun exposure, alone or with vitamins C and E; five percent melatonin in ethanol, propylene glycol, and water; and 5.85 microliters of solutions containing 1.2-5% melatonin, alone or with vitamins C and E.

Children (under 18 years old)
There is limited research on melatonin supplements in children, and their safety is not established. Melatonin may increase seizure risk in children; caution is advised, and use of melatonin should be discussed with a healthcare provider.

For inflammation or respiratory distress syndrome in newborns, 10 doses of melatonin (10 milligrams per kilogram) have been given, with two hours in between the first four doses, four hours in between the fifth and sixth doses, eight hours in between the seventh and eighth doses, and 12 hours in between the ninth and 10th doses.
For circadian rhythm sleep disorders in children with and without vision problems, 3-12 milligrams of melatonin has been taken by mouth daily for eight weeks.
For delayed sleep phase syndrome, 3-6 milligrams of melatonin has been taken by mouth daily for 10-28 days.

For insomnia, 1-5 milligrams of melatonin have been taken by mouth once nightly for up to two months. Doses of 0.05-0.15 milligrams per kilogram of melatonin have been taken by mouth nightly for one week.
For Rett’s syndrome, 2.5-7.5 milligrams has been taken by mouth once daily at bedtime for up to two years.
For sedation, 3-6 milligrams of melatonin has been taken by mouth 10 minutes before standard sedation.
For seizure disorder, 1.5-10 milligrams of melatonin has been taken by mouth daily for two weeks to three months.

For sepsis (severe response to infection), two 10-milligram doses, separated by one hour, have been taken by mouth 12 hours after diagnosis.
For sleep disorders in children with behavioral, developmental, or mental disorders, 0.1-10 milligrams has been taken by mouth daily for one week to 72 months.
For sleep disturbance, 2-10 milligrams of melatonin has been taken by mouth nightly before bedtime for four weeks to three months.

For surgery, 0.1-0.5 milligrams per kilogram of melatonin has been taken by mouth in 1-3 doses before surgery, with standard painkillers or anesthesia.
For nighttime urination, five milligrams of melatonin has been taken by mouth nightly for three months.
For pain, a single dose of 10 milligrams per kilogram of melatonin has been injected into the vein.

Safety
The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies
Avoid with known allergy or sensitivity to melatonin or related products. Melatonin has been linked to allergic skin reactions and autoimmune hepatitis (liver inflammation caused by immune cells attacking the liver).
Side Effects and Warnings

Melatonin is likely safe when taken by mouth in commonly studied doses for up to three months, typically 1-20 milligrams. In children, melatonin is likely safe for long-term use in recommended doses.

Melatonin may cause abnormal heartbeat, aggression, amnesia, bedwetting (in children), body pain, changes in body temperature or feeling cold, changes in cholesterol levels, changes in the immune system, chest pain, confusion, decreased sperm count, delusions, disorientation, dizziness, eye damage or glaucoma (increased eye pressure), fatigue or irregular sleep-wake schedule, fogginess, hallucinations, headache, hormonal effects, hyperactivity, increased heart rate, increased seizure risk (particularly in children), inflammation, insomnia, irritability, mood changes, muscle control problems or weakness, musculoskeletal disorders, nightmares, nighttime awakening, poor sleep quality, psychotic symptoms, skin reactions (flushing, itching, painful lumps, paleness, and rash), sleepwalking, slow reaction time, stomach or intestinal disorders (changes in appetite, cramping, diarrhea, esophagus inflammation, nausea, odd taste in the mouth, stomach pain, and vomiting), vivid dreaming, weakness, worsened behavior, and yawning.

Melatonin may affect blood pressure. Caution is advised in people taking drugs, herbs, or supplements that affect blood pressure.
Melatonin may affect blood sugar levels. Caution is advised in people with diabetes or low blood sugar and those taking drugs, herbs, or supplements that affect blood sugar. Blood sugar levels may need to be monitored by a qualified healthcare professional, including a pharmacist, and medication adjustments may be necessary.
Melatonin may affect the risk of clotting. Caution is advised in people with bleeding or clotting disorders and those taking drugs that may affect bleeding. Dosing adjustments may be necessary.

Drowsiness or sedation may occur. Use caution in people who are driving or operating heavy machinery (including aircraft) and those taking depressants, stimulants, or sedatives.

Melatonin may interfere with the way the body processes certain drugs using the liver’s cytochrome P450 enzyme system.
Use cautiously in people who have or are at risk of changes in hormone levels, eye disorders, frequently feeling cold, genital or urinary disorders (including children with a history of bedwetting), heart disease, hyperactivity, immune disorders, inflammatory disorders, mental disorders, muscle control problems, nervous system disorders, seizures, skin disorders, and stomach and intestinal problems.

Use cautiously in people taking agents that affect the immune system, anti-inflammatory agents, or hormonal agents.
Use cautiously in breastfeeding women, due to a lack of safety information.
Avoid in women who are pregnant or trying to get pregnant. Melatonin may decrease sex drive, increase the risk of developmental disorders, and reduce ovarian function.
Avoid in people with known allergy or sensitivity to melatonin or related products.
Pregnancy and Breastfeeding

Overall, there is a lack of high quality scientific evidence on the use of melatonin during pregnancy or breastfeeding.
Use cautiously in breastfeeding women, due to a lack of safety information.
Avoid in women who are pregnant or trying to get pregnant. Melatonin may decrease sex drive, increase the risk of developmental disorders, and reduce ovarian function.

Interactions
Interactions with Drugs
Note: This section discusses both melatonin in the body and melatonin from other sources, and the effects of other agents on melatonin and when taken with melatonin. Many drugs may lower natural melatonin levels in the body. These include nonsteroidal anti-inflammatory drugs (NSAIDs, including ibuprofen [Motrin®, Advil®] or naproxen [Naprosyn®, Aleve®]), beta-blocker blood pressure medications (including propranolol [Inderal®], atenolol [Tenormin®], and metoprolol [Lopressor®, Toprol®]), and agents that lower levels of vitamin B6 in the body (including birth control, hormone replacement therapy, loop diuretics, hydralazine, and theophylline). Other agents that may affect melatonin levels include caffeine, diazepam, estradiol, somatostatin, temazepam, verapamil, and vitamin B12.

Melatonin may affect the risk of clotting. Caution is advised in people with bleeding or clotting disorders and those taking drugs that may affect bleeding or clotting. Dosing adjustments may be necessary.

Melatonin may affect blood sugar levels. Caution is advised when using medications that may also affect blood sugar. People taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.
Melatonin may affect blood pressure. Caution is advised in people taking drugs that affect blood pressure.

Melatonin may interfere with the way the body processes certain drugs using the liver’s cytochrome P450 enzyme system. As a result, the levels of these drugs may be altered in the blood and may cause altered effects or potentially serious adverse reactions. People using any medications should check the package insert and speak with a qualified healthcare professional, including a pharmacist, about possible interactions.
Melatonin may increase the amount of drowsiness caused by some drugs. Examples include benzodiazepines such as lorazepam (Ativan®) or diazepam (Valium®), barbiturates such as phenobarbital, narcotics such as codeine, some antidepressants, and alcohol. Caution is advised while driving or operating machinery.

Melatonin may also interact with ACE inhibitors, agents passed by the kidneys, agents that affect blood vessel width, agents that affect GABA, agents that affect the immune system, agents that affect the nervous system, agents that harm the liver, agents that increase seizure risk, agents that increase urine flow, agents that protect against radiation, agents that regulate body temperature, agents that treat Parkinson’s disease, agents that treat seizures, alcohol, Alzheimer’s agents, anesthetics, antiaging agents, antiarthritis agents, antiasthma agents, anticancer agents, anti-inflammatory agents, antiparasite agents, antipsychotic agents, antiulcer agents, antivirals, anxiety agents, birth control, caffeine, calcium channel blockers, cholesterol-lowering agents, cognitive agents, dental agents, dextromethorphan, ear agents, epithalamin, estrogens, exercise performance agents, eye agents, fertility agents, flumazenil, genital and urinary disorder agents, glaucoma agents, headache agents, heart agents, heart rate-regulating agents, hormonal agents, isoniazid, lithium, lung agents, magnetic fields, methamphetamines, methoxamine, musculoskeletal agents, neuromuscular blockers, opioids, osteoporosis agents, pain relievers, remifentanil, sevoflurane, skin agents, stomach agents, tacrine, thyroid hormones, vaccines, valproic acid, and weight loss agents.

Interactions with Herbs and Dietary Supplements
Note: This section discusses both melatonin in the body and melatonin from other sources, and the effects of other agents on melatonin and when taken with melatonin. Many drugs may lower natural melatonin levels in the body. These include nonsteroidal anti-inflammatory drugs (NSAIDs, including ibuprofen [Motrin®, Advil®] or naproxen [Naprosyn®, Aleve®]), beta-blocker blood pressure medications (including propranolol [Inderal®], atenolol [Tenormin®], and metoprolol [Lopressor®, Toprol®]), and agents that lower levels of vitamin B6 in the body (including birth control, hormone replacement therapy, loop diuretics, hydralazine, and theophylline). Other agents that may affect melatonin levels include caffeine, diazepam, estradiol, somatostatin, temazepam, verapamil, and vitamin B12.

Melatonin may affect the risk of clotting. Caution is advised in people with bleeding or clotting disorders and those taking herbs and supplements that may affect bleeding or clotting. Dosing adjustments may be necessary.
Melatonin may affect blood sugar levels. Caution is advised when using herbs or supplements that may also affect blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.
Melatonin may affect blood pressure. Caution is advised in people taking herbs or supplements that affect blood pressure.

Melatonin may interfere with the way the body processes certain herbs or supplements using the liver’s cytochrome P450 enzyme system. As a result, the levels of other herbs or supplements may alter in the blood. It may also alter the effects that other herbs or supplements possibly have on the cytochrome P450 system.
Melatonin may increase the amount of drowsiness caused by some herbs or supplements.

Melatonin may also interact with 5-HTP, ACE inhibitors, Alzheimer’s herbs and supplements, anesthetics, antiaging herbs and supplements, antiarthritis herbs and supplements, antiasthma herbs and supplements, anticancer herbs and supplements, antidepressants, anti-inflammatory herbs and supplements, antioxidants, antiparasite herbs and supplements, antipsychotic herbs and supplements, antiulcer herbs and supplements, antivirals, anxiety herbs and supplements, birth control, caffeine-containing herbs and supplements, chasteberry, cholesterol-lowering herbs and supplements, cognitive herbs and supplements, dental herbs and supplements, DHEA, ear herbs and supplements, echinacea, exercise performance herbs and supplements, eye herbs and supplements, fertility herbs and supplements, folate, GABA, genital and urinary disorder herbs and supplements, glaucoma herbs and supplements, headache herbs and supplements, heart herbs and supplements, heart rate-regulating herbs and supplements, herbs and supplements passed by the kidneys, herbs and supplements that affect blood vessel width, herbs and supplements that affect GABA, herbs and supplements that affect the immune system, herbs and supplements that affect the nervous system, herbs and supplements that increase seizure risk, herbs and supplements that increase urine flow, herbs and supplements that protect against radiation, herbs and supplements that regulate body temperature, herbs and supplements that treat Parkinson’s disease, herbs and supplements that treat seizures, hormonal herbs and supplements, light therapy, lithium, liver herbs and supplements, lung herbs and supplements, magnetic fields, meditation, musculoskeletal herbs and supplements, music therapy, neuromuscular blockers, osteoporosis herbs and supplements, pain relievers, phytoestrogens, skin herbs and supplements, stomach herbs and supplements, thyroid hormones, and weight loss herbs and supplements.

Share Button